What Medicaid Cuts Mean for Chronic Pain

Untreated childhood pain follows to adulthood

https://www.medpagetoday.com/opinion/second-opinions/115803

As pediatric pain psychologists, we often wish we had a magic wand that could wave away the suffering that children and their families bring into our offices. However, we know that good pain management for kids isn’t magic. It’s science. And it depends first and foremost on access to consistent, high-quality healthcare.

People are often shocked to learn that they have probably known a child with chronic pain. In fact, one in five children and adolescentsopens in a new tab or window suffer with chronic pain during their youth, making chronic pain one of the most common and overlooked disorders in childhood. Yet, for these millions of children with recurring pain, there are less than 60 pediatric pain centersopens in a new tab or window in the U.S. Pain scientists and clinicians have worked tirelessly to build these truly lifesaving programs. Still, even with years of effort, the scale of need so vastly outweighs the available resources that most families will never gain access. And now, proposed cuts to Medicaid threaten to make the situation even worse.

We meet the families that are lucky enough to access care in clinic every day. Children often arrive to their first appointments with limited physical functioning and must relearn how to move their bodies. Some show up with mobility devices and a goal of walking without assistance; others are striving to re-learn how to socially function, regulate pain-related fear, or just develop habits that help their bodies learn to sleep well at night again. Pain science has made all of these goals realistic for the majority of kids who can access good care.

Without Medicaid support, however, many children will continue to have limited functioning and difficulty returning to their lives. For the fortunate families who are able to access pediatric pain treatment centers, the results are often observed by parents to be miraculous.

For example, consider a 16-year-old female athlete who arrived at her first appointment in a wheelchair. She had difficulty getting out of bed and walking independently. She described her pain as unbearable — a feather touch to the skin yielding fiery discomfort. She had missed more school than she had attended over the past year. Her parents had to shift job schedules to take care of her. Basketball team texts became MyChart appointment reminders. The family’s whole life was engineered to fit the agenda of pain. Fortunately for this family, they were able to access an interdisciplinary team of trained pain specialists, including pain medicine physicians, pain psychologists, physical therapists, and occupational therapists. As a team, these providers were able to offer evidence-based treatment to help this athlete return to the classroom, to her sports, to her friends, and ultimately, to herself. The family could rebuild their life after 6 months of pain rehabilitation.

This is just one example of the many children we see whose lives have been twisted beyond recognition because of a chronic pain syndrome. For the family mentioned above, they were able to receive early intervention and make steady progress. However, this is not the case for families who get access to the right care too late, or never get access at all. When patients do not receive early intervention, they can develop severe chronic pain. Treatment becomes a slow and arduous march, sometimes taking months to years of therapies before a child and their family can recover functioning. It is our collected decades of experience working in the trenches with these children and families that drives our plea to ensure pediatric pain treatment is not luxury care. It is evidence based, life-altering recovery.

Children’s lives and futures are at risk right now. Without Medicaid, children will lose access to treatments like ours that quite literally give them their lives back. The proposed federal budget cutsopens in a new tab or window to Medicaid will deepen the gap between what kids need and what families can access. If we allow that to happen, we aren’t just ignoring suffering — we’re ensuring it.

Here’s the rub: ensuring childhood pain isn’t only about kids; it ensures another generation of adults with serious pain conditions. That is a reality we are intimately familiar with in this country. Childhood pain that goes untreated or undertreated is one of the strongest predictors of chronic pain in adulthood. We’ve lived through one opioid epidemic — one born in part from our failure to offer strong, early solutions for pain. If we cut off access now, we’re not just abandoning children in pain — we may be setting the stage for some version of an Opioid Epidemic 2.0. And with it, an even larger burden on our future workforce, healthcare system, and economy.

To be sure, children with private insurance will still have access to high-quality pain care, but Medicaid is the backbone of all pediatric healthcare in the U.S., covering nearly half of all childrenopens in a new tab or window. Approximately 37 million childrenopens in a new tab or window in the U.S. are enrolled in Medicaid or the Children’s Health Insurance Program (CHIP), and Medicaid accounts for more than $4 billionopens in a new tab or window in pediatric pain-related healthcare per year. In many pediatric pain programs, Medicaid is the most common payor. While Medicaid is administered through the individual states, federal funding matches at least 50%opens in a new tab or window of what states contribute. Without federal funds, fewer children will have access to pain care; though their symptoms will remain, and likely amplify over time.

We are asking you to please call your legislators. Urge them to protect Medicaid funding and remove cuts. Pediatric pain care isn’t optional. For the children and families we serve — some of whom may also be your patients, or perhaps even your children, grandchildren, nieces, nephews, and neighbors, and the youth who will one day be charged with carrying forward our society — it’s essential, life-changing care.

Filed under: General Problems